Maine nursing homes and hospitals battling deadly gut infection

Maine ranks second in the nation for deaths from a nasty infection spread in health care facilities, according to new data.

The bug, called Clostridium difficile, is a gastrointestinal bacteria that most often strikes people who are both taking antibiotics and receiving medical treatment. The infection is linked to 14,000 deaths each year nationwide, according to the Centers for Disease Control and Prevention.

Maine’s mortality rate from the germ is 5.5 deaths per 100,000 people, second only to Rhode Island, where C. difficile results in 8.2 deaths per 100,000 people, according to Extending the Cure, a Washington, D.C.-based project on antibiotic resistance funded by the Robert Wood Johnson Foundation.

The ranking is based on 2007 data. It shows the highest death rates from C. difficile in the Northeast.

Dr. Stephen Sears, Maine state epidemiologist, said the Extending the Cure data was dated, but stressed that C. difficile remains a serious concern in Maine.

“It’s very common and very severe and it’s causing problems for people,” he said.

Maine began seeing more deaths from C. difficile in 2006, following an outbreak of a virulent and more toxic strain of the bacteria in Canada, Sears said.

Infection and death rates from C. difficile have reached historic highs while other health-care-related infections are on the decline. Deaths related to the infection jumped 400 percent between 2000 and 2007, according to the CDC.

C. difficile appears to have eclipsed Methicillin-Resistant Staphylococcus aureus, an antibiotic-resistant “superbug” that has wrought havoc on hospitals.

“By most people’s examination it’s become a bigger problem than MRSA,” Sears said.

C. difficile causes diarrhea that can progress to sepsis and death, particularly among the elderly. It can exist in the body without causing illness.

When a person takes antibiotics, good bacteria in the gut are killed off, leaving a ripe environment for C. difficile to grow, Sears explained. If that person then visits a hospital, nursing home or other health facility, they can pick up the germ from contaminated surfaces or a health care provider’s hands.

The C. difficile bacteria produces a hardy spore that can linger in dust and dirt, Sears said. Especially troubling is that alcohol-based hand sanitizers don’t kill the germ.

“The spores are extremely resistant,” Sears said. “You have to actually use bleach to clean them.”

C. difficile has traditionally been associated with hospitals, but a CDC report released this week shows that just a quarter of infections show up in hospital patients. The rest appear in nursing home patients or people recently treated in doctors’ offices and clinics.

“A lot of C. difficile is in long-term care,” Sears said. “That’s a reflection of the health care system, because that’s where sick people on antibiotics go.”

The germ can spread as patients transfer back and forth among various health care facilities.

Hospital stays related to the bacteria add at least $1 billion in extra costs to the health care system, the CDC estimates.

Key to preventing the infection is avoiding unnecessary antibiotics and frequent hand-washing, he said. Patients taking antibiotics should also check with their doctor if they develop diarrhea, Sears said.

The CDC found that C. difficile prevention efforts in Massachusetts, Illinois, and New York hospitals have cut infections by 20 percent in under two years.

Maine outpaced many other states last year by passing new legislation that requires reporting of C. difficile infections following hospital admissions, Sears said.

Hospitals began submitting that data in January. The figures won’t become publicly available until after a months-long validation process by health officials.

In 2008, a consortium of Maine hospitals banded together to work toward preventing health-care-related infections.

“A lot has been put into place to try to minimize C. difficile, but a lot more can be done,” Sears said.